Peripheral Arterial Disease and Its Association With Arsenic Exposure and Metabolism in the Strong Heart Study. 

 -  2016 
<br/><br/> At high levels, inorganic arsenic exposure is linked to peripheral arterial disease (PAD) and cardiovascular disease. To our knowledge, no prior study has evaluated the association between low-to-moderate arsenic exposure and incident PAD by ankle brachial index (ABI). We evaluated this relationship in the Strong Heart Study, a large population-based cohort study of American Indian communities. A total of 2,977 and 2,966 PAD-free participants who were aged 45-74 years in 1989-1991 were reexamined in 1993-1995 and 1997-1999, respectively, for incident PAD defined as either ABI <0.9 or ABI >1.4. A total of 286 and 206 incident PAD cases were identified for ABI <0.9 and ABI >1.4, respectively. The sum of inorganic and methylated urinary arsenic species (As) at baseline was used as a biomarker of long-term exposure. Comparing the highest tertile of As with the lowest, the adjusted hazard ratios were 0.57 (95% confidence interval (CI): 0.32, 1.01) for ABI <0.9 and 2.24 (95% CI: 1.01, 4.32) for ABI >1.4. Increased arsenic methylation (as percent dimethylarsinate) was associated with a 2-fold increased risk of ABI >1.4 (hazard ratio = 2.04, 95% CI: 1.02, 3.41). Long-term low-to-moderate As and increased arsenic methylation were associated with ABI >1.4 but not with ABI <0.9. Further studies are needed to clarify whether diabetes and enhanced arsenic metabolism increase susceptibility to the vasculotoxic effects of arsenic exposure.  Copyright © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0002-9262 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Arsenic/ur [Urine]<br/>*Diabetes Mellitus, Type 2/eh [Ethnology]<br/>*Indians, North American/sn [Statistics & Numerical Data]<br/>*Peripheral Arterial Disease/eh [Ethnology]<br/>Age Factors<br/>Aged<br/>Aged, 80 and over<br/>Ankle Brachial Index<br/>Antihypertensive Agents/ad [Administration & Dosage]<br/>Arizona/ep [Epidemiology]<br/>Biomarkers<br/>Blood Pressure<br/>Cholesterol, LDL/bl [Blood]<br/>Cohort Studies<br/>Environmental Exposure/ae [Adverse Effects]<br/>Female<br/>Glomerular Filtration Rate<br/>Hemoglobin A, Glycosylated/an [Analysis]<br/>Humans<br/>Hypertension/ep [Epidemiology]<br/>Hypoglycemic Agents/ad [Administration & Dosage]<br/>Incidence<br/>Male<br/>Menopause<br/>Middle Aged<br/>Midwestern United States/ep [Epidemiology]<br/>Prospective Studies<br/>Risk Factors<br/>Sex Factors<br/>Smoking/eh [Ethnology]<br/>Socioeconomic Factors
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Health Research Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article